Delivering Health Care in America: A Systems Approach, 3rd ed, by Leiyu Shi and Douglas Singh. Sudbury, MA: Jones and Bartlett; 2004. 652 pages, softcover, $59.95.
Given the complexity of health care delivery in the United States, writing a book clearly describing this system that is not really a system seems a daunting task. Leiyu Shi and Douglas Singh accomplish that task carefully and comprehensively in Delivering Health Care in America: A Systems Approach. As participants in one of the largest segments of the US economy, it is imperative that we in health care accept the challenge to understand the components of this conglomerate and how it works. This book, designed for undergraduate and graduate students in health related fields, assists in that challenge. As a survey text, the authors attain a remarkable breadth without overly compromising depth.
A well developed organizing model provides a framework to return to repeatedly while reading the 452 pages. Using a systems framework, the authors arrange the content in 5 sections. Section one, entitled System Foundations, speaks to the cultural beliefs and historical developments of the current system (Chapters 2 and 3). Sections two, three, and four comprise the System Features aspect of the model and cover System Resources, System Processes, and System Outcomes. System Resources deals with human and nonhuman resources (Chapters 4, 5, and 6). System Processes includes the continuum of care (chapters 7, 8, 9), and special populations (Chapters 10 and 11). System Outcomes contains chapters on cost, access, and quality (Chapter 12) and on health policy (Chapter 13). Section five, System Outlook, provides some ideas and predictions about the future of health services delivery (Chapter 14). The visual representation of the model provided in Chapter 1 is one to return to at the beginning and end of each chapter to situate that particular content in the context of the whole.
This third edition of the book is current and well documented including topics such as SARS, the pressure for Medicare prescription benefits, homeland security, bioterrorism, and the nursing shortage. Over 50 tables and more than 100 figures complement the written text. An extensive glossary of terms and equally impressive list of acronyms and abbreviations help make this essentially a reference text. Research is frequently cited to support statements about particular components of the system. Examples include research correlating improved patient outcomes with RN care and descriptive studies showing patients' preferences for nurse practitioners as primary providers. Woven throughout the chapters are discussions of system developments and attempted changes as well as the factors that affected those developments or ensured the success or failure of attempted change. By the end of the book, the reader not only understands the components of the system but why they exist as they do.
Reading the book as a whole may be somewhat laborious since there is unavoidable repetition in some chapters. However, most persons reading Delivering Health Care in America will be professors preparing for a survey class or students in these classes, and they will likely be reading the book over several months or read a particular chapter as a supplement to other assignments. As a survey text, there are some aspects missing such as a discussion of magnet hospitals and nursing staff in the chapter on hospitals. Nurses and nurse practitioners are addressed primarily in the chapter on health service professionals. I was surprised that the landmark IOM meta-analyis related to access to care for persons of color is not included in either the access or the special populations chapter. The chapter on Primary Care includes a misunderstanding of the term Primary Health Care as used by the World Health Organization. However, these are relatively minor problems in a text designed to provide a synopsis of the system and how it works. Overall, the text is quite comprehensive.
As a teacher of baccalaureate nursing students, I find this book most helpful in providing an overview of the historical origins of the current system, the cultural values that constrain change in the system, and the resources, processes, and outcomes of this system, unlike any in the world. We must understand an entity before we can take steps to improve it.